Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPC4754 | FL |
NPI | 1013269661 |
---|---|
Provider Name | Danielle Callegari |
First Address | Jacksonville, FL 32256-5484 |
Second Address | Jacksonville, FL 32256-5484 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2012 |
Last Update Date | 05/10/2012 |